Evaluation of GRAMPA Score Measuring Motor Abilities of Elderly Patients

In the field of geriatrics, the Standardized Geriatric Approach (SGA) which is the benchmark for assessing elderly patients, consists of evaluating the medical, psychological and functional capacity dimensions of the elderly subject, among others. This approach is defined as a "multidimensional and interdisciplinary diagnostic process that seeks to assess the medical, psychological and functional capacity of the frail elderly person, with the aim of developing a coordinated and integrated long-term treatment and follow-up plan".

Mobility or functional capacity, an essential component of AGS, is generally studied in terms of balance, walking and basic movement, as in the Tinetti tests, the Timed up and go or walking speed. According to the French National Authority for Health (HAS), "the ability to perform basic movements largely determines the level of physical dependence. The important stages in assessing mobility and the quality of the strategies used are: raising in bed, turning on one side in bed, getting out of bed, moving from sitting to standing and from standing to sitting'.

After a review of the literature, investigators were unable to find any scales that could study the ability to perform basic movements in a comprehensive and graded manner. The Minimum Motor Test (MMT), a score created in 2005 with the aim of observing motor abilities and establishing rehabilitation objectives for patients suffering from psychomotor maladjustment syndrome, does not allow exhaustive evaluation of basic movements and is not very sensitive for distinguishing between two patients unable to hold the standing position (15 items /20 requiring standing). In particular, it does not include bed raising and sit-to-stand transfers. The test is based on clinical observations using two scoring levels: if the answer to the question asked is 'yes', the score awarded is 1; if the answer is 'no', the score awarded is 0. The maximum total score that can be obtained is 20. A high score means that good physical ability has been retained.

The AGGIR grid assesses dependency on the basis of activities performed or not performed. In addition, all basic movements are grouped together in a single item, which does not provide detailed information on the capabilities of elderly people.

The Activities of Daily Living (ADL) assesses independence in activities of daily living in the broadest sense, but does not specifically target functional motor skills. A score of 6 determines the maximum level of autonomy. The overall score varies from 0 (totally dependent) to 6 (best possible independence). Measuring ADLs is relevant for all elderly people, regardless of where they live.

Thus, investigators created a score, the GRAMPA score, to assess motor abilities more comprehensively that will include the following basic movements:

• Getting up in bed
• Turning on one side in bed
• Sitting at the edge of the bed
• Stand up
• Move around a small perimeter (bedroom)
• Sitting up
• Return to bed

In the GRAMPA score, these basic movements are characterised according to 3 grades of autonomy:

• Unassisted: The patient carries out the basic movement alone, without technical aid or verbal guidance.
• Partial assistance: The patient needs technical assistance, i.e. equipment, and/or verbal guidance to carry out the basic movement.
• Significant assistance: The patient needs human assistance to carry out the basic movement, i.e. as soon as the carer puts his/her hands on the patient to mobilise or support him/her, and/or the carer handles the heavy equipment needed to carry out the transfer.

Investigators believe that the GRAMPA score (GRaduation de l'Autonomie Motrice des Personnes Agées) would be a better reflection of the motor abilities of elderly subjects, by studying their ability to move in a restricted environment (e.g. a hospital room).

A more accurate estimate of basic functional motor skills would help to improve communication between healthcare professionals and optimise treatment by adapting strategies to the patient's level of functional autonomy (patient dependence in terms of equipment layout, rehabilitation objectives and limiting iatrogenic dependence).

As the metrological qualities of the score have not been validated, it will not be used to modify the management of patients included in the study.

There will therefore be no significant benefit or risk for participating patients.

Patients' motor skills are information that is communicated very regularly between healthcare professionals, and which is essential for helping patients regain their independence and organising care in a rehabilitation department. In particular, this information can be used to choose the technical aids best suited to patients' autonomy, or to decide on the possibility of a return home.

In particular, this score would enable better inter-professional communication about patients' functional abilities, leading to improved conditions for patient care by professionals.